Nokea
The nurse is teaching a client with ulcerative colitis who has been prescribed sulfasalazine (Azulfidine). What clinical manifestations will the nurse tell the client to be particularly alert for when taking this drug?
- A. Flu-like symptoms
- B. Purplish rash
- C. Skin blisters
- D. Anorexia
- E. Nausea
Correct Answer: A, B, C, E
Rationale: Sulfasalazine side effects include flu-like symptoms (A), purplish rash (B), skin blisters (C), and nausea (E). Anorexia (D) is less common.
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A female client is started on warfarin (Coumadin) 5 mg po bid. To adequately evaluate the effectiveness of the warfarin therapy, the nurse must know that this medication:
- A. Dissolves any clots already formed in the arteries
- B. Prevents the conversion of prothrombin to thrombin
- C. Interferes with the synthesis of vitamin K-dependent clotting factors
- D. Stimulates the manufacturing of platelets
Correct Answer: C
Rationale: Thrombolytic agents (e.g., streptokinase) directly activate plasminogen, dissolving fibrin deposits, which in turn dissolves clots that have already formed. Heparin prevents the formation of clots by potentiating the effects of antithrombin III and the conversion of prothrombin to thrombin. Warfarin prevents the formation of clots by interfering with the hepatic synthesis of the vitamin K-dependent clotting factors. Platelets initiate the coagulation of blood by adhering to each other and the site of injury to form platelet plugs.
The nurse is caring for a client with suspected endometrial cancer.
- A. Frothy vaginal discharge
- B. Thick, white vaginal discharge
- C. Purulent vaginal discharge
- D. Watery vaginal discharge
Correct Answer: D
Rationale: Endometrial cancer often presents with abnormal uterine bleeding, which can manifest as watery vaginal discharge. Frothy discharge is more typical of trichomoniasis, thick white discharge suggests a yeast infection, and purulent discharge indicates infection, none of which are primary symptoms of endometrial cancer.
During morning assessments, the nurse finds that a client's nephrostomy tube has been clamped. The nurse's first action should be to:
- A. Assess the drainage bag.
- B. Check for bladder distention.
- C. Unclamp the tubing.
- D. Irrigate the tubing.
Correct Answer: C
Rationale: Unclamping the nephrostomy tube is the priority to restore urine flow and prevent complications like hydronephrosis or infection.
The pediatrician has diagnosed tinea capitis in an 8-year-old girl and has placed her on oral griseofulvin. The nurse should emphasize which of these instructions to the mother and/or child?
- A. Administer oral griseofulvin on an empty stomach for best results.
- B. Discontinue drug therapy if food tastes funny.
- C. May discontinue medication when the child experiences symptomatic relief.
- D. Observe for headaches, dizziness, and anorexia.
Correct Answer: D
Rationale: Giving the drug with or after meals may allay gastrointestinal discomfort. Giving the drug with a fatty meal (ice cream or milk) increases absorption rate. Griseofulvin may alter taste sensations and thereby decrease the appetite. Monitoring of food intake is important, and inadequate nutrient intake should be reported to the physician. The child may experience symptomatic relief after 48-96 hours of therapy. It is important to stress continuing the drug therapy to prevent relapse (usually about 6 weeks). The incidence of side effects is low; however, headaches are common. Nausea, vomiting, diarrhea, and anorexia may occur. Dizziness, although uncommon, should be reported to the physician.
When interviewing parents who are suspected of child abuse, the nurse would use which of the following interview techniques?
- A. Be direct, honest, and attentive.
- B. Approach them in the emergency room as soon as you suspect abuse to 'clear the air' right away.
- C. Ask the parents what they could have done differently to prevent this from happening to the child.
- D. After the interview, call child protective services.
Correct Answer: A
Rationale: The nurse must be honest, direct, professional, and attentive in her interview to gain the parent's trust. The nurse should approach the parents in private, away from the child. Asking them to relive and evaluate the situation may be looked at as placing blame on the parents for the child's 'accident.' At this point, the parents may get defensive and stop communicating. Although you may call child protective services, the nurse should inform the parents of their responsibility to do this and explain the process to them.